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Quadriceps or hip exercises for patellofemoral pain? A randomised controlled equivalence trial
  1. Rudi Hansen1,2,
  2. Christoffer Brushøj2,
  3. Michael Skovdal Rathleff3,4,
  4. S Peter Magnusson2,5,
  5. Marius Henriksen6
  1. 1Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
  2. 2Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
  3. 3Center for General Practice, Aalborg University, Aalborg, Denmark
  4. 4Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
  5. 5Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
  6. 6The Parker Institute, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Frederiksberg, Denmark
  1. Correspondence to Mr Rudi Hansen, Department of Physical and Occupational Therapy, Bispebjerg Hospital, Copenhagen, Denmark; rudi.hansen{at}


Objective To assess effectiveness equivalence between two commonly prescribed 12-week exercise programmes targeting either the quadriceps or the hip muscles in patients with patellofemoral pain (PFP).

Methods This randomised controlled equivalence trial included patients with a clinical diagnosis of PFP. Participants were randomly assigned to either a 12-week quadriceps-focused exercise (QE) or a hip-focused exercise (HE) programme. The primary outcome was the change in Anterior Knee Pain Scale (AKPS) (0–100) from baseline to 12-week follow-up. Prespecified equivalence margins of ±8 points on the AKPS were chosen to demonstrate comparable effectiveness. Key secondary outcomes were the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire pain, physical function and knee-related quality of life subscales.

Results 200 participants underwent randomisation; 100 assigned to QE and 100 to HE (mean age 27.2 years (SD 6.4); 69% women). The least squares mean changes in AKPS (primary outcome) were 7.6 for QE and 7.0 for HE (difference 0.6 points, 95% CI −2.0 to 3.2; test for equivalence p<0.0001), although neither programme surpassed the minimal clinically important change threshold. None of the group differences in key secondary outcomes exceeded predefined equivalence margins.

Conclusion The 12-week QE and HE protocols provided equivalent improvements in symptoms and function for patients with PFP.

Trial registration number NCT03069547.

  • Knee injuries
  • Randomized Controlled Trial
  • Exercise Therapy
  • Rehabilitation

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors RH: concept/design, data collection, data analysis, manuscript draft, critical revision. MH: concept/design, data analysis, critical revision, guarantor. NCB: concept/design, medically responsible, eligibility screening, critical revision. MSR: concept/design, critical revision. SPM: critical revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.